Join us for our Medicare Supplement
Insurance Seminar

STEP 1: Which seminar would you like to attend?

Please select a date, time and location for your seminar.

Number attending:

STEP 2: Register for a seminar

STEP 2: Can you tell us more about you?

Please provide the information below to complete seminar registration:

Would You Like To Hear From Us?

Even though you cannot attend an upcoming seminar, United Insurance Services and our team of Ambassadors are still here to help. Please let us know if you would like to continue receiving information from UIS by selecting all that apply below.

Please call me to schedule a no-obligation appointment.

Please keep me on your US mailing list for information about future seminars, Medicare Supplement Insurance, pricing and updates.

Please e-mail me information about future seminars, Medicare Supplement Insurance, pricing and updates.

Please remove me from your mailing list.

STEP 2: Confirm Address

Step 2: Can you tell us more about you?

Please provide or update your information below so we may fulfill your request:

STEP 3: Medicare Eligibility Information

Step 3: Medicare Eligibility Information

We ask the following questions so we may provide you with current information that is pertinent to your personal situation:

Have you already retired? Yes No

Estimated date of retirement:

Have you enrolled in Medicare Part B? What is Medicare Part B? Yes No

Do you currently have Employer/Group Coverage? Yes No

Will you have Employer/Group Coverage after retirement? Yes No Not sure

I will need a Medicare Supplement Insurance Plan in: 1 - 3 months 4 -6 months 7-12 months Over 12 months

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